[Disclosure of Own Crisis And Treatment Experiences By Staff Of Psychiatric Institutions In BerLin And Brandenburg - An Underused Resource For Reducing Stigma?]

AIM

This article is part of the EKB-study which explores lived crisis and treatment experiences of mental health professionals in Berlin and Brandenburg. It addresses the disclosure of mental health workers' lived experiences in their workplace.

METHOD

An online survey was conducted among 182 mental health professionals, containing questions on disclosure of lived experiences. Data were analyzed descriptively and analytically.

RESULTS

Participants reported disclosure mainly to supervisors and affiliated colleagues. Experiences were mostly positive, with severe negative exceptions. Central motives against disclosure were fear of vulnerability, fear of compromising professional identity, and shame.

CONCLUSIONS

Disclosure of lived crisis experiences is not always the proper strategy for mental health professionals. Disclosure may be a means of reducing public and internalized stigma.

A Bibliometric Review of Constituents, Themes, and Trends in Online Medical Consultation Research

As an emerging form of health care with accelerated growth in recent years, online medical consultation (OMC) has received extensive attention worldwide. Although the number of studies on OMC has increased substantially, few provide a comprehensive and up-to-date review of OMC's research constituents, themes, and trends. This study, therefore, extracted 1,801 OMC-related articles published in English from the Web of Science (WoS) Core Collection database during the past 30 years and employed a bibliometric analysis of WoS and CiteSpace to examine major constituents' distribution, collaboration relationships, themes, and trends. The results indicate that the United States, England, and China contributed the most to the proliferation of OMC studies. The United States had the greatest academic influence and the most collaborative connections, while China demonstrated the sharpest increase and most active development in recent years. However, there is a lack of substantial and close collaboration between researchers worldwide. The main themes of OMC research were Internet hospitals, COVID-19, mixed methods, online health community, and information technology. Researchers have recently shifted their attention to social media, management, efficacy, word of mouth, mental health, and anxiety. This review paper provides researchers and practitioners with a holistic and clear understanding of the features and trends of OMC research. It also identifies potential areas for future OMC research and sheds light on OMC practices.

Better Data from AI Users: A Field Experiment on the Impacts of Robot Self-Disclosure on the Utterance of Child Users in Home Environment

Data are one of the important factors in artificial intelligence (AI). Moreover, in order for AI to understand the user and go beyond the role of a simple machine, the data contained in the user's self-disclosure is required. In this study, two types of robot self-disclosures (disclosing robot utterance, involving user utterance) are proposed to elicit higher self-disclosure from AI users. Additionally, this study examines the moderating effects of multi-robot conditions. In order to investigate these effects empirically and increase the implications of research, a field experiment with prototypes was conducted in the context of using smart speaker of children. The results indicate that both types of robot self-disclosures were effective in eliciting the self-disclosure of children. The interaction effect between disclosing robot and involving user was found to take a different direction depending on the sub-dimension of the user's self-disclosure. Multi-robot conditions partially moderate the effects of the two types of robot self-disclosures.

Self-disclosure, empathy and anxiety in nurses

PURPOSE

This study aimed to examine the relationship between self-disclosure, empathy, and anxiety in nurses.

DESIGN AND METHODS

The study was conducted with 255 nurses working in hospitals in Turkey. Data were collected using a Sociodemographic Form, the Self-Disclosure Scale (SDS), the Basic Empathy Scale (BES), and the Spielberger State-Trait Anxiety Inventory (STAI).

FINDINGS

A statistically significant positive relationship was found among the SDS, BES, and Spielberger STAI.

PRACTICE IMPLICATIONS

Psychiatric nurses should ensure the reduction of nurses' anxiety levels by planning different interventions such as psychotherapy, counseling, and training. They may determine nurses' self-disclosure and empathy skills as well as their needs.

Therapist self-disclosure: Let's tackle the elephant in the room

Therapist Self-Disclosure (TSD), the revealing of a therapist's feelings, thoughts or personal information to a client, is an inevitable aspect of therapeutic relationships. However, despite its prevalence in clinical settings, we believe there is insufficient recognition and exploration of TSD in our work with children and adolescents. Because TSD is not often formally addressed during training, therapists across the spectrum of clinical child psychology and psychiatry are often left with the belief that disclosures are rare or inherently negative occurrences that should be avoided. As a byproduct, therapists often develop a blind spot to many disclosures that they make and are thus underprepared to navigate the complex decision-making process that surrounds TSD. In our article, we address the elephant in the room: that most therapists disclose in some form or other. In addressing this topic, we hope to encourage replacement of avoidance and silence with discourse and reflection around TSD occurrences. We explore developmental considerations pertinent to child and adolescent clients as well as suggest a framework for TSD decisions. We feel that improved supervision and clinical practice around TSD is a worthy and achievable aim that merits further recognition, consideration and educational focus.

When to disclose and to whom? examining within- and between-client moderators of therapist self disclosure-outcome associations in psychodynamic psychotherapy

Objective: While previous studies have indicated that therapists' self-disclosure (TSD) can have curative effects, the contextual variables that may moderate the link between TSD and treatment outcome have not been sufficiently explored. Using session-by-session psychotherapy data, we examined the extent to which within-client distress and between-clients emotion regulation difficulties moderated the associations between TSD and session outcomes.Method: The sample comprised 68 clients treated according to the principles of psychodynamic psychotherapy by 47 therapists in a university clinic. Emotion regulation difficulties were assessed at the beginning of treatment, and functioning and distress levels as well as symptoms were assessed at the beginning of each session. After each session, therapists completed a measure of frequency and centrality of their immediate and non- immediate self-disclosure interventions during the session.Results: At the within-client level, in sessions marked by high pre-session client distress, immediate TSD was associated with a better next session outcome. At the between-clients level, for clients who had low emotion regulation difficulties, immediate TSD was marginally associated with better outcomes.Conclusion: These findings highlight the importance of considering within-client level as well as between-clients level variables when deciding upon self-disclosure.

A qualitative exploration of what works for migrant adolescents in transcultural psychotherapy: perceptions of adolescents, their parents, and their therapists

BACKGROUND

Migrant adolescents are at a higher risk than their native-born counterparts of psychiatric disorders, and their care is a public health issue. In France, transcultural psychotherapy is a treatment provided by a group of therapists designed to meet the specific needs of these patients when usual care appears ineffective. The objective of this study was to explore the therapeutic elements at work in transcultural psychotherapy.

METHODS

We conducted a qualitative study crossing the perspectives of adolescents receiving transcultural psychotherapy, their parents, their first-line therapist (FLT), and the transcultural therapists. The families were chosen by purposive sampling. Data were collected during semi-structured individual (for FLTs) and group (families and transcultural therapists) interviews that explored the therapeutic elements involved and effective in transcultural psychotherapy. We used interpretative phenomenological analysis (IPA) to examine the data. In all, 44 participants were questioned: three adolescents (2 girls and 1 boy, all aged 18 to 21 years) and their parents (3 mothers and 1 father), three FLTs (2 child psychiatrists and 1 psychologist), and the 34 therapists participating in the three transcultural psychotherapy groups.

RESULTS

The analysis uncovered three themes: (1) the perceived effectiveness of the group's functioning; (2) the recounting of the individual, family, and cultural history to allow for complexity and nuance; and (3) the personal investment by therapists, made possible by the group.

CONCLUSIONS

Our results show some therapeutic elements at work in transcultural psychotherapy that enable it to meet the particular needs of some migrant adolescents that are unmet in standard therapy. Continuing to study transcultural psychotherapy and assess its effectiveness is essential for promoting and optimizing psychiatric care for migrant adolescents.

The Importance of Genuineness in Public Engagement-An Exploratory Study of Pediatric Communication on Social Media in China

There is a growing need for the public to interact with pediatricians through social media in China, and genuineness is a crucial factor contributing to effective communication, but few studies have examined the relationship between genuineness and its effect on public engagement. This study developed a four-dimension framework including self-disclosure, genuine response, functional interactivity, and genuineness in Chinese culture to investigate the effect of genuineness in the communication of Chinese social media influencers in pediatrics on public engagement. Content analysis was employed to examine these dimensions and the related public engagement in 300 social media posts on the largest microblogging site in China. The findings indicate that genuine response was positively associated with the number of comments and positive comments, while negatively related to the number of shares. Functional interactivity made the site more appealing, resulting in likes and shares. Genuineness in Chinese culture was reflected in engagement through sharing posts by the public. This study is the first to develop an integrated framework to measure genuineness in online health communication and contributes to the understanding of the effect of genuineness on Chinese public engagement in social media.

Effects of Genetic Counselor Self-Disclosure: an Experimental Analog Study

The complex nature of self-disclosure poses challenges for genetic counselors in clinical practice. We examined the impact of genetic counselor self-disclosure on observer perceptions of the counselor. In an online analog study, 123 participants watched a 3-minute video of a simulated genetic counseling session. For half the participants, the video showed the counselor disclosing that she had a family medical history similar to the patient (direct personal disclosure). For half the participants, the counselor revealed her experience with other patients (direct professional disclosure). Half the participants in each video condition read that the patient had discovered personal information about the counselor during a pre-session web search (indirect personal disclosure); half read that the patient learned of the counselor's FAQ webpage for prospective patients (indirect professional disclosure). Participants in the direct personal disclosure conditions gave higher ratings to the counseling relationship on an abbreviated version of the Barrett-Lennard Relationship Inventory and rated themselves more likely to see the counselor compared to those in the direct professional disclosure conditions. The content of the indirect disclosure conditions (personal or professional) had no effect. Brief, direct, verbal disclosure of session-relevant personal information by a genetic counselor appears to enhance the counselor-patient relationship and increase the likelihood of patients returning to the counselor.

Patients' perspectives on political self-disclosure, the therapeutic alliance, and the infiltration of politics into the therapy room in the Trump era

The primary aim of this study was to investigate the effects of the 2016 United States presidential election and ensuing political climate on patients' experiences in psychotherapy. A sample of 604 self-described Democrat and Republican patients from 50 states participated in the study. Results showed that most therapists disclosed their political stance (explicitly or implicitly) and most patients discussed politics with their therapists. 64% of Clinton supporters and 38% of Trump supporters assumed political similarity with their therapist. Stronger patient-reported alliance levels were found for patients who (a) perceived political similarity; (b) reported implicit therapist political disclosure; and (c) found in-session political discussions helpful. Additionally, Clinton (but not Trump) supporters reported significant pre-post-election decreases in expression of positive emotions and increases in both expression of negative emotions and engagement in discussions about socio-political topics. Our findings suggest that the current political climate infiltrates the therapeutic space and affects therapeutic process and content.

Therapeutic Self-Disclosure within DBT, Schema Therapy, and CBASP: Opportunities and Challenges

In recent years, various therapeutic interventions have been established that extended behavior and cognitive behavior therapy (CBT) by so-called “third-wave” strategies. In order to address specific therapeutic challenges in certain subgroups of patients who do not sufficiently respond to “classical CBT,” some of these third-wave strategies put particular emphasis on therapist self-disclosure. This article highlights therapeutic self-disclosure as a means to address interpersonal problems by comparing three third-wave strategies: (a) acceptance and change strategies as used in Dialectical Behavioral Therapy (DBT), (b) the concept of “limited reparenting” as used in Schema Therapy (ST), and (c) disciplined personal involvement as used in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). On the basis of a critical discussion on opportunities and challenges within these three concepts, self-disclosure is proposed to be a promising therapeutic tool that is worth to be investigated in more depth in future studies.

Therapist self-disclosure and the therapeutic alliance in the treatment of eating problems

Evidence is mixed regarding the potential utility of therapist self-disclosure. The current study modelled relationships between perceived helpfulness of therapist self-disclosures, therapeutic alliance, patient non-disclosure, and shame in participants (n = 120; 95% women) with a history of eating problems. Serial multiple mediator analyses provided support for a putative model connecting the perceived helpfulness of therapist self-disclosures with current eating disorder symptom severity through therapeutic alliance, patient self-disclosure, and shame. The analyses presented provide support for the contention that therapist self-disclosure, if perceived as helpful, might strengthen the therapeutic alliance. A strong therapeutic alliance, in turn, has the potential to promote patient disclosure and reduce shame and eating problems.

Considerations for Culturally Responsive Cognitive-Behavioural Therapy for Māori With Depression

A strong case can be made for adapting cognitive-behavioural therapy (CBT) for ethnic and cultural minority groups. In North America, literature is readily available for CBT practitioners wishing to adapt their practice when working with ethnic minority groups (e.g., Latino, African-American, and Native American groups). In other countries such as New Zealand, literature of this sort is scarce, and the empirical foundation for CBT adaptation in these parts of the world is weak. This article documents the core tenets of an empirically validated CBT treatment protocol tailored for individual delivery to Māori clients suffering from depression in New Zealand and developed through consultation with an expert advisory group consisting of senior clinicians and Māori cultural experts. The result is a series of considerations for clinicians endeavouring to provide culturally responsive CBT with Māori clients, who are identified and organised into four domains. Two case studies are presented to illustrate the practical application of the proposed techniques. Links are made to international literature related to the adaptation of CBT in pursuit of cultural responsiveness.

Culturally adapted cognitive behaviour therapy for Māori with major depression

Māori are the indigenous people of New Zealand and in 2006 comprised approximately 15% of the country's population. Epidemiological data suggests Māori experience rates of depression that are higher than the general population and are less likely to engage in treatment for mental health issues. The main aim of this study was to evaluate the effectiveness of an adapted approach to psychotherapy with Māori. The broad goals of which were to provide empirically grounded guidance for therapists aspiring to provide best practice to their Māori clients. This paper documents the evaluation of a cognitive behavioural therapy (CBT) treatment protocol specifically designed and adapted for delivery to adult Māori clients with a diagnosis of depression. The treatment protocol was administered to 16 Māori clients with a primary diagnosis of depression. The adapted treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. The intervention exhibited considerable promise with large significant reductions in depressive symptomatology in the participant group. Furthermore, significant reductions in negative cognition were observed. This is the first piece of applied clinical research that has examined the effectiveness of an individual psychological therapy exclusively with Māori and the first to examine individual psychotherapy outcomes with an indigenous population using an effectiveness study. The findings have a number of implications for the treatment of Māori clients with depression. This study provides useful guidelines for clinicians providing psychological treatment to Māori and provides strong support for the cultural adaptation of psychological treatment with ethnic minority groups.

Lesbian and Queer Women Professors Disclosing in the Classroom

Lesbian and queer women professors are faced with the personal decision of whether to disclose their sexual identities in the classroom. The experiences of 10 participants in Calgary, Canada were explored through semi-structured, one-on-one interviews. The analysis revealed one overarching category: enacting authenticity. The sub-themes within this major finding include fighting for one’s identity, modeling authenticity, and the freedom and connection felt by self-disclosing. Three supplementary findings and the sub-themes within are also expanded and discussed: classroom structure factors, self-disclosure timing, and negative impacts of disclosure. The findings imply that despite the potential negative impacts of disclosing in the classroom, this pedagogical technique can be used as a means of demonstrating genuineness and praxis toward social justice. The professors’ collective emphasis on the role of authenticity in disclosing in the classroom offers prospects for subsequent research efforts regarding the visibility of marginalized identities in academic settings.

Understanding the art of feminist pedagogy: facilitating interpersonal skills learning for nurses

The purpose of this study is to explore feminist pedagogy integrated with facilitation skills. A pedagogy project was undertaken with students participating in the BSc (Hons) Nursing programme, whereby a module, "Interpersonal Skills for Nurses" was developed for 72 year 1 students. A feminist pedagogy involves employing the powers of diversity to create an environment where all students' voices are heard. It values the power of sharing to create a community of learners in which teachers and students share their talents, skills and abilities to enhance the learning of all (Chinn, 2001). An end of semester evaluation provided feedback which indicated this was a valuable module to teach year 1 student nurses. It highlighted that student nurses found the topic both interesting and relevant and felt it was taught in a way that promoted their personal development and identity as a nurse.

Reversals of Sudden Gains Made During Cognitive Therapy with Depressed Adults: A Preliminary Investigation

Background: This study investigated sudden reversals during cognitive therapy (CT), through the comparison of “in-session” activity and “out-of-session” life events. Method: The sample comprised 20 clients who experienced sudden gains during CT for depression: 10 who subsequently suffered a reversal of this gain and 10 matched clients who maintained progress. Measures of client resistance and therapist responses were scored by judges from session transcripts and clients completed measures of life events and depression at each session. This enabled the Reversal and Non-Reversal groups to be compared during pre-sudden gain, pre-reversal or matched sessions. Results: No differences were apparent between the Reversal and Non-reversal groups or between the pre-gain and pre-reversal sessions in terms of client or therapist “in-session” activities. In the Reversals group, 6 out of 10 clients recovered their level of symptom improvement, following the reversal. Therapists showed higher levels of reflection and self-disclosure with clients who did not recover their symptom gain following the Reversal than with clients who did recover their symptom gain following the Reversal. Conclusions: The study is discussed in terms of the manner by which reversals can be more effectively measured and researched.

The Significance of Therapist Genuineness From the Client's Perspective

Therapist authenticity is viewed as an important therapeutic process. The client's experiencing of the process and significance of therapist genuineness is, however, under-researched. In a case study ( N = 6), the authors analyzed the clients' experiencing of the overall significance of therapist genuineness in their therapy. Both qualitative and quantitative data were gathered and analyzed using the technique of pattern matching. The authors found that clients also experienced processes other than genuineness as crucial therapeutic processes. Nevertheless, the results show that therapist genuineness can be a crucial therapeutic process. The findings imply that whether and how genuineness is crucial for change also depends on the individual client.

Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents: A Meta-Analysis

We conducted a meta-analysis using 20 randomised controlled studies of cognitive behavioural therapy (CBT) for anxiety disorders in children and adolescents. The mean pre-post effect size was d = 0.94, which was maintained at follow-up. The mean effect size when comparing the CBT and control group was d = 0.61. Within the CBT group, the mean effect size of university clinics (d = 0.77) was larger than that of other clinics (d = 0.37). The difference in effect sizes was hardly noticeable when comparing CBT with family or parents and CBT with child only (d = 0.03). Further studies are required to examine the effectiveness of family CBT versus child CBT.

Prevention of Childhood Emotional Disorders: Reducing the Burden of Suffering Associated with Anxiety and Depression

Anxiety and depression are the most common mental health problems affecting young people today. This review presents a description of the prevalence and impact of these emotional disorders in children and youth. While treatment offers one approach to intervening, research indicates that most sufferers will not actually receive clinical intervention, and of the minority who do, many will terminate prematurely, fail to respond, or experience recurrent difficulties despite treatment. Prevention approaches offer an alternative and adjunct to treatment, and have become a priority for governments, offering a cost effective and efficient means of providing services to children and youth prior to the onset of psychopathology. This review describes current practises in prevention research and provides an overview of an Australian developed cognitive-behavioural programme that has acquired a solid evidence-base as well as popularity in schools as one approach to building emotional resilience in children and youth, whilst effectively reducing the burden associated with emotional disturbances of anxiety and depression. Future directions for prevention practice and research are highlighted.

Is self-disclosure part of the genetic counselor's clinical role?

The role of genetic counselor self-disclosure in clinical practice is unclear as there are few published investigations of this issue. In the present study, 11 genetic counselors who previously received genetic services were interviewed about their opinions and use of disclosure. Several themes were extracted from their responses. All participants reportedly disclosed to patients; however, not all disclosed their receipt of genetic services. Patient requests for self-disclosure influenced many participants' disclosure decisions. Opinions regarding potential benefits of disclosure varied. Nearly all participants stressed the importance of self-disclosing judiciously, stating that it may be counterproductive to client goal attainment. Four individuals with expertise in genetic counseling and psychotherapy were invited to react to these themes and to provide their opinions of self-disclosure. Their views are compared to those of the present sample, and practice and research recommendations are given.